Rabbi Fischer has NOT followed the order of the NYC DHMH (Dept Health and Mental Hygiene). He is under a Temporary Restraining Order and Preliminary Injunction since 11-24-04, and, as of the most recent court documents dated last monday (3-14-05), has still not submitted himself to the DHMH for testing. There is actually a court date set for today, so today things could change. Check out these 2 posts from Chakira. The court documents show that Fischer was first reported in 2003, and again in October 2004, with the twins. Once there are 3 cases, the DHMH by law has to investigate. Rabbi Tendler did not make any of the disputed statements until December 8, 2004. No mesira was needed at that point. I have the documents myself. Read on:(from Chakira.blog-city.com)A visitor made this comment,Well, here is some news: I have a copy of the most recent court documents in front of me and they say that in regards to RF: "Defendant has failed to comply with the terms of the Order of the Commissioner, [which was] dated November 24, 2004, in that he has failed to cease and desist from engaging in MBP, that he has failed to submit blood specimens to the DHMH to test for the presence of HSV 1 antibodies, and that he continues to perform circumcisions without surgical gloves." And in another paragraph, "Defendant has not complied with the terms of the order in that he has failed to appear at the DOHMH Health Center to provide a medical history, blood samples, and swabs of skin and oral mucosa." (direct quotes)it just doesn't make sense. RF should just comply with the health department and the whole issue will go away! This has all happened before, with another mohel in NY, and since he was found positive, he just agreed to not do MBP with direct contact, and everything was ok. If that mohel would have been found negative there would have been no consequences. Here is the direct quote about that from the court document footnote: "In 1998, DOHMH worked with the religious community affected regarding an incident of an infant reported with herpes infection after a different mohel performed MBP. The mohel was linked to two cases of neonatal herpes, one in 1988, and one in 1998. Working with the community, DOHMH was able to fulfill its mandate to investigate and to resolve the matter, in that the mohel agreed to cease practicing MBP."It seems to me that RF should just get tested and if he is negative, fine, and if he is positive, fine, either way, there should be some cooperation. The documents also state: "DOHMH is not attempting to interfere with the ritual of circumcision, but, rather, wants to ensure that the practice of ritual circumcision does not result in disease transmission."The documents that I have are the latest court documents (accurate as of last Monday) filed by the DHMH against RF for a Temporary Restraining Order and Preliminary Injunction that are on record with the Supreme Court of the State of New York, New York County, which is where the court case is being filed. This is the formal Temporary Restraining Order and Preliminary Injunction dated 12-23-04, with the judge's written comments on it, the last of which is dated March 14, 2005, last Monday. The reason the Temporary Restraining Order (TRO) was filed in December 2004 is because RF had violated the Order of the Commissioner against the defendant, RF, which was made on 11-24-04, (this is the order that was made for RF to get tested on either November 30, 2004, or December 1, 2004, and wear gloves during Milah etc etc.) The judge's notes on the complaint are current as of March 14, 2005, and show that the TRO is still in effect, due to RF not coming to the DHMH to get tested, and the next hearing about the TRO is scheduled for tomorrow, 3/21/05. This shows that RF indeed was not tested in February 2005, and he has thus far (as of 3/14/05) not complied with the court order (which was in November 2004) to get tested by the DHMH. The Rockland Journal News' is only referring to the State subpoenaing the medical records of RF, not the results, because there have been no tests yet, and those medical records were received February 11, 2005. The TRO is still in effect, at least till tomorrow, because RF has not submitted himself for testing to the DHMH as he was ordered to do on November 24, 2004. This whole thing might have been a non-issue if RF had complied right away, as the case with the other Mohel illustrates.The documents also refer to a 3rd baby who was infected in 2003, in Staten Island, NY, and who was diagnosed with HSV 1 after milah with MBP by rabbi fischer. NY State Health Code requires that if there are 3 incidences of a disease such as herpes, the DHMH are required to investigate. Here is the paraphrased quote: The NY State Health Code Law 11.03(a) requires that all doctors and hospitals are legally bound to report to the Department of Health and Mental Hygiene (DOHMH) all diagnosis [not only deaths] from a list of certain communicable (contagious) diseases that are listed, among them is Herpes Simplex Virus 1 within 24 hours of the diagnosis, by phone and in writing. Law 11.03(b) says that the DOHMH "shall conduct an investigation to ascertain the sources or causes of the infection, and shall take steps to prevent morbidity and mortality". Background info, as stated in Temporary Restraining Order and Preliminary Injunction: One infant died on 10/26/04 from HSV 1 and his twin brother also was infected by HSV 1. Milah was done on these babies on 10/16/04, using MBP by Mohel Fischer. Another baby had previously been reported to the DOHMH that had been infected with HSV 1 after MBP by Mohel Fischer in late 2003, in Staten Island. The DOHMH is concerned that the defendant may be spreading this, and in accordance with the Health Code is required to investigate these three instances.

just to clarify: in my intro to the last post, i meant to say: Rabbi Fischer has NOT followed the order of the NYC DHMH (Dept Health and Mental Hygiene). He is under an Order of the Comissioner since 11-24-04, and, since he has violated that, he is under a Temporary Restraining Order and Preliminary Injunction since 12-23-04.The rest of the post is pretty much a direct quote from the documents though.

According to the official court documents, the DHMH has been investigating a bris by RF done in Staten Island where the infant contracted HSV 1. The court documents speak for themselves. The Order of the Comissioner actually states that the bris in 2003 was with MBP, so it is very possible that there is a different case as well, besides the one in Rabbi Marcus' shul. Who knows? Regardless, if a mohel has HSV 1, he is a danger whether he does MBP or not, if he doesn't wear sterile gloves. That is why the Order of the Comissioner against RF states that he has to stop MBP, get tested, and wear sterile surgical gloves: (direct quote)""Enjoining the defendant from performing any circumcisions involving the practice known as oral MBP, or any practice in which he allows his mouth or oral fluids to come into contact with an infant's genitals, or any other procedures on infants that involve exposing infants to his bodily fluids, including saliva, or oral or *****bare hand contact with the genitals or other mucous membranes of infants ******(emphasis added), until such a time as DOHMH has completed its investigation of defendant as a possible source of herpes simplex virus type 1 in infants, (then it goes on to detail that RF has to submit blood and tissue specimens for testing etc etc) In another paragraph: " [You must] appear in person at the Department's Health Facility [in Manhattan] on 11/30/04 or 12/1/04 to provide a complete medical history, blood samples, swabs of skin and oral mucosa, so as to enable the Department to conduct such laboratory tests as may be necessary for herpes simplex virus type 1 (HSV 1), to determine if you are capable of transmitting HSV 1 infection to other persons. You must bring with you 2 pieces of photo ID containing your full name and address, and you are further ordered to wear sterile surgical gloves." Herpes Simplex Type 1 is a saliva borne disease, so it can be passed if the saliva is on your hands as well, and then there is direct contact with an open wound.

Assuming RF only has latent HSV-1 antibodies (which independent tests have shown to be the case) he is no different than over 90% of the general population.(CDC statistics)

1)Are we going to require all Mohelim to wear gloves?2)Are we going to require all nurses to wear gloves before they handle babies in the hospital nursery?3)Are we going to require all parents to don surgical gloves before they touch their 3 month old?4) Are we going to make kissing one's child illegal?

As the judge said today (03/21/05)the NYDHMH must prove within one week that there is more risk with RF than any other mohel, health -care provider etc. or the TRO will be lifted.Let's get real.

In the comments on chakira, there is a link, to a shiur that R' Tendler gave on Mila (if YU has not taken the link down, due to some 'privacy' issues). In that shiur, he says that there is this mohel in Monsey, who is practicing metzitzah bepeh and has been infecting babies and he has to be stopped either we will publicize and etc.) That shiur was given in Jan. 2004. At that point, the baby in Staten Island was the only one infectetd and at that bris, RF used a kli.

rmco: in response to your points:1) responsible mohelim who care about the infant's life (or death), if they KNOW THAT THEY ARE HSV carriers, SHOULD wear gloves2) Nurses in the hospitals are not placing their saliva, or touching babies' open wounds, and when they do touch, they DO wear gloves, as do ALL health care providers observing universal precautions3) if a parennt knows that he/she is HSV carrier, then the parent shouldn't be touching their mouth to their 3 month old's open bleeding wound,4)kissing their child? i won't even bother to respond.And about what the judge "said" on 3-21-05? you know that's not what he said. we'll see soon enough what the real story with RF's "compliance" is.

Most respected infectious disease specialists including Dr. Hirschman of Mount Sinai MC, Dr. Fleicshman of UCLA and others are of the opinion that, unlike HSV-2, HSV-1 does not shed orally and that this entire issue is a red (maztes) herring.

RMCO: Perhaps you are misquoting the doctors. Or misunderstanding. (Or the doctors are arguing with the rest of the world of oral medicine and pathology, but hopefully that isn't the case) Any pathologist knows that HSV-2 is the STD, usually found below the waist, and HSV-1 is saliva borne. It is extremely uncommon for HSV-1 to be transmitted below the waist, but it can happen. Look it up in any Oral Pathology text, ask your local oral surgeon, ask an oral pathologist, etc. Here is a quote from the authorative text "Oral and Maxillofacial Pathology" by Neville,Damn,Allen&Bouquot, 2nd ed, pg 212:"HSV-1 is spread predominantly through infected saliva or active perioral lesions. HSV-1 is adapted best and performs more efficiently in oral,facial,and occular areas.The pharynx,intraoral sites,lips,eyes,and skin above the waist are involved most frequently.HSV-2 is adapted best to the genital zones, is transmitted predominantly by sexual contact, and typically involves the genitalia, and skin below the waist. Exceptions to these rules do occur,and HSV-1 can be seen in a pattern similar to that of HSV-2, and vice versa." Is that enough? And the whole issue is a red herring to cover up what? Mohelim have been investigated before (see the posts on chakira and others where the verbatim text from the court documents is quoted, never mind, i'll copy and paste it into here)quoted verbatim: "In 1998, DOHMH worked with the religious community affected regarding an incident of an infant reported with herpes infection after a different mohel performed MBP. The mohel was linked to two cases of neonatal herpes, one in 1988, and one in 1998. Working with the community, DOHMH was able to fulfill its mandate to investigate and to resolve the matter, in that the mohel agreed to cease practicing MBP." And there has been no attempt at regulating milah. In fact, most people never heard of the other mohelim who transmitted HSV-1, that's how low key it was, and sadly, that is how low key RF's case COULD have been.

Clearly "active" HSV-1 is shed orally. But there is no scientific evidence that "latent" HSV-1 sheds orally.Even the puerile 07/04 Pediatrics article (try as they may) could not find one study linking the two. If the CDC statistics are to be believed, (that over 90% of adults have HSV-1 anti-bodies) then there is no diff between RF and 90% of Mohelim. Why should he fall, or be pushed , on his sword. (Perhaps in the 1988/98 cases you quote, the Mohelim had "active" HSV-1.)

rmco: "then there is no diff between RF and 90% of Mohelim" OK, if 90% of the population is positive, how much of the population are mohelim? let's say 0.5% of the population are mohelim, isn't that 0.5% of the 90%? I may be wrong at that, I am not a statistician, but it doesn't sound right that it equals 90%. But I digress. RF is the same as any other mohel who KNOWS he is infected with HSV-1, latent or active. He must act responsibly and assure that he doesn't pass on the infection. Whether the latent infection sheds or not, how about when he is active?if one has latent HSV-1, then there ARE times when the virus is active, such as when the immune system is down a little, then the virus comes out, and is called active. This lasts a short period of time, and afterwards, the blood results can indicate a recent active infection for several weeks post infection. Are you saying that there is proof that RF did NOT have an active infection at the time of the bris? How do you know he wasn't active? He is, according to your claim of an independent test, HSV-1 positive for the latent infection. That means that he DOES get the active infection. And since he has not been tested, or according to you, if he was tested, was it within several weeks of the milah of the twins (on 10/16/04) as the DHMH Order of the Commissioner ordered him to? No, because he refused to get tested by the DHMH during the period of time when there might have been some evidence whether he had the active infection during the milah. It certainly seems that if RF is really innocent and NEVER had the active infection at the time of the milah of the twins, (to cover your assertion, let's assume that latent does not shed) he should have gotten tested immediately by the DHMH to prove his innocence from an active infection. You must agree that by his actions, he is not playing the role of the innocent man. And since there are times when he must be active, at some point during his distinguished career, has he ever been known to refuse MBP when it was requested, or wear gloves, because he had the active HSV-1, known as a cold sore? I don't know the answer to that one, but correct me if I am wrong, I would suspect he hasn't.

1)RF has many-a-time asked the father or another attendee (including myself) to do MBP because he had a cold or other reason he was hesitant. This is common practice amongst all mohelim I know.2)Common practise is for mohelim to get tested (blood and saliva) frequently for any communicable disease. RF tests himself at *** lab every three weeks.Upon attorney's advice, RF refused to have the DHMH testing done, unless all other individuals caring for the infant agreed to have the same test done. The parents and the home-nurse attendant refused. Afterall, the HSV lesions were not on the front nor anywhere near the incision. If anyone is at fault, it is the pediatrician whom the family consulted before the Bris.RF, upon pre-bris visit, notified the parents that there is bad rash with white spots on the buttocks and he would not perform the bris unless their doctor examined the child and agreed.

Again, if 90% of the population has latent HSV-1 (anyone whoever had a cold sore in their adult life) so do 90% of all mohelim. With out any testing, we must assume that 9 out of ten brisos are done by a mohel with HSV.

rmco, the court file indicates that the health dept. is indeed seeking other possible sources for the virus in the twins (obviously, i can't vouch for any follow-up, though). there is also the 2003 staten island case linked to the same mohel. if, as you say, the mohel is frequently tested, even on his own terms, why is there not even a mention of that in the record? why is there no mention of what you say is a discrepancy in location or timing of the "rash"? why is there no mention of others' refusl ro be tested? wouldn't the mohel's lawyer raise those glaring omissions to the judge? i would imagine the judge being pretty upset with the city if that would be the case. yet, with 12 in-person or telephone conferences referenced in the record, none of that is mentioned. so confused.

Anon.At the 03/14/05 hearing the judge raised these questions.The DHMH asked for 3 months to investigate. The judge refused. At the 03/21/05 hearing the judge gave the NYC DHMH 7 days to prove that it is more likely than not that the infection came from RF than any other source. Tough to prove.In all likelihood the TRO will be lifted next week.